Acute Ilness Inclass (no panopto) Flashcards
When should children seek medical care for dehydration?
-Dry mucous membranes
-crying without tears
-no UOP for 4-6 hours
-sunken eyes
-blood in stool
-abdominal pain
-vomiting for >24hrs
-fever > 103
-lethargy
-polyuria (DKA)
How to treat dehydration in children?
Oral rehydration/fluid replacement
-Pedialyte®, Rehydralyte®, Enfalyte®, CeraLyte®
contains electrolytes and some sugar (enhances water and sodium absorption)
What is the common dose of IV bolus for dehydration?
IV bolus 20 ml/kg of 0.9%, max 1000 ml
up to 30-60 min
Fluid doses by weight
<10 kg: 100 ml/kg
maintenance: 4 ml/kg/hr
11-20 kg: 1000ml + 50 ml/kg for each kg > 10
-> maintenance: 40 ml/hr + 2 ml/kg/hr
> 20 kg: 1500ml + 20 ml/kg for each kg > 20
-> maintenance: 60 ml/hr + 1 ml/kg/hr
Calculating fluid deficit (in Liters)
% dehydration x weight (Kg) = #Liters needed
Drugs for acute pain
strong pain: Strong opioids (morphine, fentanyl) -> weaker opioids (Morphine)
weak pain: NSAIDs or Tylenol
At what age does a newborn have the PK/PD activity as an adult?
age of 1
Which drugs for pain are restricted by the FDA in children?
-codeine
-cough medicine
-tramadol
What are the treatment goals for the common cold in children?
-Symptomatic relief (congestion and cough)
-Hydration
What are the non-drug therapy options for the common cold?
-Vaporizer (cool mist only)
-Warm juice or lemonade
-Honey (in those > 1 year)
-Nasal aspiration
Pharmacotherapy for the common cold
-Antihistamines, antitussives, decongestants,
expectorants, and analgesics
Babies of which age should NOT use cough and cold meds?
not recommended for babies under 6 years
-lack of data supporting use
-parents overdosing
-ADE: CNS stimulation/depression, lethargy, tachycardia, hallucination, hyperactivity
OTC products to recommend in the common cold
-Suctioning of nasal secretions with a bulb syringe
-Saline nose drops or spray
-topical decongestants
-Honey for cough only in kids > 1 year of age (due to infant botulism -> weakness, constipation)
-Tylenol or NSAIDs for pain
Cough in babies is usually NOT treated, when should treatment be considered?
-Cough leading to consecutive nights of poor
sleep and/or vomiting
-Cough leading to rib fractures
-Cough severe enough to lead to hypoxia
Treatment for irritant cough
-Nasal saline
-Increased humidification
-Honey (older than 1)
-Vapor rub (not in asthmatics bc menthol, and eucalyptus can trigger asthma)
-Antihistamines (for post-nasal drip)
-Albuterol/inhaled corticosteroids
-Dextromethorphan, guaifenesin, benzonatate (>10)
When is a patient considered constipated?
<3 bowel movements a week
>1 episode of fecal incontinence
-history of excessive stool retention
-painful bowel movement
-large fecal mass
-large diameter stool blocking the toilet
must meet 2 of these criteria for 1 month or longer
Definition of Encopresis and Soiling
Encopresis: Involuntary or voluntary passage of stool at regular intervals
Soiling: Involuntary passage of stool
Which diseases can cause constipation in children?
-Hirschprungs disease (segment of the colon without peristalsis)
-high Ca+
-low thyroid
-cows milk allergy
-anatomic (perianal fistula)
-CF (cystic fibrosis)
Which drugs cause constipation?
Opiates, Phenobarbital, Antacids
What helps for constipation in children?
-Toilet training methods
-behavioral
Drugs:
Miralax: 17 g PO Q1H while awake for “cleanouts”
Golytely if severe
OTC: senna, sorbitol, bisacodyl, docusate, rectal suppositroies, enemas
What temperature is considered a fever?
-rectal temperature: >100.4° F (38°C)
-Ear temperature: >100.4° F (rectal mode), >99.5°F (37.5°C) in oral mode
-Oral temperature: >99.5°F (37.5°C)
-Temporal artery: >100.4° F (38°C)
Which temperatures are considered core temperature?
Rectal, ear, temporal artery -> if over 100°F it is fever
rectal is more accurate
What is the most common cause of fever in children?
Infections, UTIs most common
sometimes with vaccines
How to use different thermometer
rectal:
-apply petroleum jelly on the thermometer
-Gently insert the thermometer into the child’s anus ¼ to ½ inch
-hold for 2 minutes (glass thermometer), or 1 minute (digital)
Oral: don’t use if they had a hot or cold drink, place it under the tongue and close your mouth for 3 minutes (glass thermometer), 1 minute (digital)
Temporal: uses an infrared scanner to measure the temperature of the temporal artery on the forehead (may be better than ear thermometer)
Axillary: place under the armpit for 4-5 minutes
Ear: keep inside the ear for 15 minutes (not reliable for children under 6 months)
When should treatment for fever in children be considered?
-Underlying medical problem
-History of febrile seizures
-Child is uncomfortable
if the child has a high temperature (>100°F) but looks fine do NOT treat
When should a child with a fever be referred to the doctor?
!!!
< 3 months: >100°F regardless of how the infant appears
> 3 months: >100°F for more than 3 days or looks ill
3-36 months: >102°F
any age: >104°F or febrile seizure, recurrent fever, chronic medical problem, new skin rash !!!
What are the treatment options for fever in children?
-Sponging and baths (tepid water 85°F)
-hydration and rest
-Tylenol: 10-15
-Ibuprofen
What is the recommended dose of Tylenol and Ibuprofen for fever in children?
Tylenol: 10-15 mg/kg/dose Q4-6 hours PRN
Ibuprofen: 5-10 mg/kg/dose
do not need exceed 5 doses a day
What is GER vs GERD?
GER: the passage of gastric contents into the
esophagus
GERD: symptoms related to GER
tips:
-keep baby upright
-avoid overfeeding
-let them burp
-put baby to sleep on their back (risk of sudden infant death)
-experiment with the diet
Symptoms of GERD in children
-failure to thrive (rate of weight gain is low)
-vomiting, refusal to eat
Respiratory:
aspiration pneumonia
URI
asthma
cyanosis
cough
Esophageal:
esophagitis
dysphasia
Chest pain (heartburn)
What is the Pathophysiology behind GERD in children?
-Transient decrease in LES tone
Overfeeding, high-fat meals
-Increased intra-abdominal pressure
excessive coughing, crying, BMs
-Impaired LES pressure/function: nicotine exposure, ß-agonists
How is GERD treated in infants?
H2-antagonists (may develop tolerance)
ADE: irritability, somnolence, headache
PPIs (longer duration, NO tolerance) - take 15-30 min before food
Prokinetic agents: not recommended. more side effects
Erythromycin, metoclopramide, baclofen
-Decrease the volume of feedings, thickening the
feeding, frequent burping
What are the key characteristics of conjunctivitis (pink eye) in an allergic reaction or bacterial or viral infection?
allergic reaction: itchy eyes
Bacterial infection: purulent eyes
viral infection: swollen eyes
Signs of Colic in babies
PURPLE
Peak pattern
Unexpected timing of episodes
Resistance to soothing
Pain-like look
Long bouts
Evening cluster of symptoms
Treatment for Colis in Children
Dicyclomine (anticholinergic) - not under 6 months !!
-Simethicone: doesn’t really work
-herbals: Camomile, vervain, licorice, fennel
What is Enuresis?
bed wetting
-voids 2x a week
-for 3 months
-at least 5 years old
Treatment for Enuresis
Non-pharm is more effective than pharmacologic treatment
-Decreasing fluid for several hours before bedtime
-Voiding before going to bed and when parents to
go bed
-Enuresis alarm
Pharmacologic:
Desmopressin (DDAVP): enhances water reabsorption
Oxybutynin (anticholinergic)
Imipramine (last line)
What are the biggest risk factors for otitis media in children?
-age under 2 y
-secondhand smoke
signs:
acute onset, ear effusion (full of fluid), inflammation
Which pathogens commonly cause ear infections in children?
-Strep pneumoniae
treatment: Amoxicillin (high dose)
-H. flu (ß-lactamase producer)
treatment: Augmentin or cephalosporin
-Moraxella catarrhalis (ß-lactamase producer)
treatment: Augmentin or cephalosporin
also:
Group A Streptococcus
Pseudomonas aeruginosa
MRSA
What is the dose of Amoxicillin for otitis media?
!!!
80-90 mg/kg/day (BID for less diarrhea)
if the child received plain Amoxicillin within the last 30 days ->
Amoxicillin/clavulanate 80-90 mg/kg/day
amoxicillin and 6.4 mg/kg/day clavulanate
What is the recommended dose frequency (BID, TID) of Augmentin based on the ratio between Amoxicillin and Clavulante?
Everything higher than 4:1 is dosed BID
if 2:1 or 4:1 -> TID
(14:1 for children < 40 kg)
What is the duration of treatment for pharyngitis in children?
10 days for all Abx (except Azithromycin)
drugs:
Penicillin, IM benzathine PEN G (X1 dose),
*amoxicillin, clindamycin, 1st gen, azithromycin
What are the symptoms that indicate referral of a Newborn to One Month of age?
-Fever of more than 100.4° F (rectal)
-Drastic change in eating habits
-Uncontrollable crying that is inconsolable
-Vomiting that continues for > 8-12 hours
-Bowel movements > 8 times per day
-Red umbilicus
-“pink eye”
-White patches on the tongue or inside the mouth
-Fast or developing rash
Refer One month to One Year
> 100.4° F (rectal) if < 3 months
101° F (rectal) if 3-6 months
104° F (rectal) if > 6 months
-Refusal to eat multiple feedings
-Extreme irritability
-Extreme drowsiness
-vomiting or diarrhea to the point of dehydration (if cannot/will not take oral fluids)
-Fast or developing rash
What is the recommended dose of Vancomycin in children and infants?
15 mg/kg/dose q6h
(adults: 15-20 mg/kg/dose q12h)
shorter interval of q6h in infants and children
